National trends and demographic disparities in perinatal non-traumatic intracranial hemorrhage mortality in the United States, 1999–2024

Abstract Background Non-traumatic intracranial hemorrhage (ICH) during the perinatal period is associated with substantial neonatal morbidity and mortality and frequently results from underlying hematologic disorders, including congenital coagulopathies, thrombocytopenia, and other hemostatic disturbances. Despite advancements in neonatal intensive care and hematologic management, there remains a critical need to understand trends and disparities in perinatal ICH mortality at the population level. This study aimed to characterize national temporal trends in perinatal non-traumatic ICH mortality and to evaluate disparities by sex, race/ethnicity, and urbanization in the United States. Methods We analyzed mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database for the period from 1999 through 2024, identifying deaths with International Classification of Diseases, 10th Revision (ICD-10) code P52 (non-traumatic intracranial hemorrhage of fetus and newborn) as the underlying cause. Crude mortality rates per 100,000 live births were calculated, along with annual percent change (APC) and average annual percent change (AAPC), utilizing Joinpoint regression analysis with Joinpoint software (version 4.9.1.0, the Surveillance Research Program of the National Cancer Institute, SEER*Stat). Temporal mortality trends were stratified by sex, race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic), and urban–rural residence. Urbanization data were available only through 2020, and mortality data for 2024 are provisional. Results From 1999 to 2024, 23,322 neonatal deaths due to non-traumatic ICH were recorded in the United States. Overall crude mortality declined from 29.06 (95% CI: 27.34 to 30.77) per 100,000 live births in 1999 to 19.79 (95% CI: 18.34 to 21.23) in 2024, representing an AAPC of –1.54% (95% CI: –2.04 to –0.87). Males consistently exhibited higher mortality rates (34.88 to 24.14 per 100,000; AAPC –1.42%) than females (22.95 to 15.25 per 100,000; AAPC –1.41%). Non-Hispanic Black infants had the highest initial mortality rates (50.64 per 100,000), with substantial improvement noted (AAPC –1.92%), although they still experienced higher rates in 2024 (30.78) compared to Non-Hispanic Whites (17.32) and Hispanics (20.42). Mortality declined in rural (AAPC –1.99%) and urban (AAPC –2.56%) areas, but rural areas continued to display slightly higher mortality rates. Conclusions National perinatal non-traumatic ICH-related mortality in the United States has significantly declined over the past two decades, reflecting improvements in neonatal and hematologic care. However, persistent disparities remain, particularly affecting male infants, Non-Hispanic Black populations, and rural communities. Targeted strategies are necessary to address these disparities and enhance equitable neonatal outcomes.